Epidemiology Cervicogenic headache

Epidemiology Cervicogenic headache

Cervicogenic

headache

Cervical headache: A type of headache (of Cervicogenic headache) which the cause is localized in the neck.
Incidence Pöllmann et al researched that the incidence and prevalence of cervicogenic headache is yet to be established.24
Sex Cervicogenic headache is more common in women 2/3rd than in men 1/3rd.4, 22, 23, 24, 25
Age Cervicogenic headache occurs in young adults or middle-aged adults between 20-50 years of age.4, 26
Pain location Neck, head, shoulder and arm.9,12,19,20,21
Pain sensation / Symptoms Cervicogenic headache often gives a constant, deep, deadening9, not booming4,9 and bearable pain.9 It is varying in intensity6,9,19 and is characterized by attacks of worsening pain.19 Characteristics that refer to the neck are important, such as reduced “range of motion” in the cervical spine1,9,16,18, 20,21 ipsilateral shoulder / arm pain9,12,19,20,21 and mechanically induce attacks. A painfully high cervical joint dysfunction can be present in cervicogenic headache.6 There may be changes in the muscle contour, tone, response to active and passive stretch, contraction and abnormal muscle tenderness may occur.16 Also, an anteroposition of the head may be present and the cervical neck flexors are weakened and / or have a reduced endurance.6Typical migraine symptoms1,21 such as nausea, vomiting, photophobia, phonophobia1,4,6, 9,19-21, dizziness, blurred vision and difficulty swallowing9,19 may occur, but are less frequent and less present than in migraine.21 Occasionally edema and redness of the eye occur9. These symptoms are ipsilateral.4,9
History of injury There may be a prior neck trauma9, 13, 21 or headache may be associated with joint degeneration.9 Pain episodes vary greatly in duration of hours or even in some cases weeks9,19. Normal duration is one to several days.9 This variation in the duration of attacks is a characteristic for these headaches. The interval between pain episodes is a few days to weeks.9 In the later stage, there is a characteristic prolonged or continuous pain accompanied by the occurrence of exacerbations. Patients with cervicogenic headache have a significantly higher frequency of headache episodes than other headache patients (17 days versus 7 days in one month).15
Provocation The pain can be provoked by neck movement, long held by non practical head positions1, 6, 9,14,15, 17,19, 21 and / or by external pressure on the n. occipitalis major.1,9,21
Diagnosis Cervicogenic headache: 20th t / m 50th year4,26
Cluster headache: 18th t / m 40 years old (M> F 7:1)
Tensionheadache: 8th t / m30th year
Literature
  1. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998;38:442-445.
  2. Smith KL, Horn C. Cervicogenic headache part 1: an anatomic and clinical overview. South African Journal of Physiotherapy 1998;54:12-21.
  3. Solomon S. Diagnosis of primary headaches disorders: validity of the international headache society criteria in clinical practice. Neurologic Clinics 1997;15:15-25.
  4. Vanagaite J, Vingen. Photophobia and phonophobia in tension-type headache and cervicogenic headache. Cephalalgia 1998;18:313-318.
  5. Vincent MB, Luna RA. Cervicogenic headache: a comparison with migraine and tension-type headache. Cephalalgia 1999;19:11-16.
  6. Watson DH, Trott PH. Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance. Cephalalgia 1993;13:272-282.
  7. Cranial Neuralgies and Facial Pain. Diagnostic criteria. Classification and diagnostic criteria for headache disorders. 1988;8.
  8. Hijdra A. Neurologie. Maarssen; Elzevier/Bunge 1994
  9. Merskey H, Bogduk N. Classification of chronic pain, discriptions of chronic pain syndromes and definitions of pain terms. Seattle; IASP Press 1994
  10. Oosterhuis HJGH. Klinische neurologie. Houten/ Antwerpen; Bohn Stafleu van Lochem 1992.
  11. Bansevicius D, Pareja JA. The ‘‘skin roll’’ test: a diagnostic test for cervicogenic headache? Functional Neurology 1998;13:125-133.
  12. Antonaci F, Ghirmai S, Bono G, Sandrini G, Nappi G. Cervicogenic headache: evaluation of the original diagnostic criteria. Cephalalgia 2001,21:573-583.
  13. Jull G, Barett C, Magee R, Ho P. Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia 1999;19:179-185.
  14. Leone M, D’Amico D, Grazzi L, Attanasio A, Bussone G. Cervicogenic headache: a critical review of the current diagnostic criteria. Pain 1999;78:1-5.
  15. Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine 1995;20:1884-1888.
  16. Pearce JMS. Are the international headache society criteria for headache useful? Cephalalgia 1996;16:289-296.
  17. Persson LCG, Carlsson JY. Headache in patients with neck-shoulder-arm pain of cervical radicular origin. Headache 1999;39:218-224.
  18. Pfaffenrath V, Dandekar R, Mayer ETH, Hermann G, Pöllmann W. Cervicogenic headache: results of computer-based measurements of cervical spine mobility in 15 patients. Cephalalgia 1988;8:45-48.
  19. Pöllmann W, Keidel M, Pfaffenrath V. Headache and the cervical spine: a critical review. Cephalalgia 1997;17:801-816.
  20. Sjaastad O, Bovim G, Stovner LJ. Laterality of pain and other migraine criteria in common migraine. A comparison with cervicogenic headache. Functional Neurology 1992;7:289-294.
  21. Sjaastad O, Joubert J, Elsås T, Bovim G, Vincent M. Hemicrania continua and cervicogenic headache. Separate headaches or two faces of the same headache? Functional Neurology 1993;8:79-83.

22 Antonaci F, Ghirmai S, Bono G, Sandrini G, Nappi G. Cervicogenic headache: evaluation of the original diagnostic criteria. Cephalalgia 2001,21:573-583.

23 Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine 1995;20:1884-1888.

24 Pöllmann W, Keidel M, Pfaffenrath V. Headache and the cervical spine: a critical review. Cephalalgia 1997;17:801-816.

25 Sjaastad O, Joubert J, Elsås T, Bovim G, Vincent M. Hemicrania continua and cervicogenic headache. Separate headaches or two faces of the same headache? Functional Neurology 1993;8:79-83.

26 Merskey H, Bogduk N. Classification of chronic pain, discriptions of chronic pain syndromes and definitions of pain terms. Seattle; IASP Press 1994

 

 Phsyical Examination

Tests:

Flexion-Rotation Test

Neck flexor muscle endurance test

Questionnaire / anamneses

Physical examination

Pressure-pain threshold” (PPT)

Manual examination

Flexion-Rotation Test
1. The patiënt lies on his or her back. The therapist stands at the head side of the patiënt. Symptoms in rest are assessed.
2. The patiënt actively flexes his or her neck as far as he or she can.
3. Then the therapist gives a full rotation to both sides of the head, with the flexion (passive!). Symptoms are assessed on both sides.
4. The test is both a pain provocation test as a range of motion test. If there is a loss of 10 degrees is measured by the therapist, this test is found positive.
Neck flexor muscle endurance test
1. The patiënt lies on his or her back.
2. The therapist positions the patiënt head so that it can be actively stabilized with 2.5 cm above the bench. (Therapist places his or her hands under the head so that the patient’s knows the position) Visually there will be a “double” chin visible anterior lateral of neck.
3. The patient is instructed to hold this position. If the patient touches the hand of the therapist or the double chin cannot be hold, the patient is instructed again.
4. A positive test is still undefined, but the test ends when the patient cannot hold the position for longer than one second.

 

 Evidence Based Practice

Quadas: Quality Assessment of Diagnostic Accuracy Studies
The Quadas helps the reader to gain clarity about what impact the BIAS had in a study. When a Quadas score is low, a critical look at the value of the study must be taken. The Quadas consists of a scoring system of 14 points to be tested.
Utility scores:

  1. Evidence strongly supports the use of this test.
  2. Evidence moderately supports the use of this test
  3. Evidence minimally supports or does not support the use of this test
  4. ? The Test has not been researched sufficiently so we are unsure of its value

 

Tests for cervicogenic headache

Flexion-Rotation Test Utility 1
Study (instab/dysf.) Sensitivity(show) Specificity(exlcude) QUADAS Score 0-14
Hall & Robinson1 86 100 12

Comment: The design of Hall & Robinson7 was pretty good and used standardized criteria for cervicogenic headache. The test possibly isolates C1-C2 and possibly doesn’t test other levels where cervicogenic headache also may occur.

 

Neck flexor muscle endurance test Utility ?
Study (instab/dysf.) Sensitivity(show) Specificity(exlcude) QUADAS Score 0-14
Harris et al.2 NT NT NA
Harris et al.2 NT NT NA
Olsen et al.3 NT NT NA

Comment: This test would benefit greatly from a validity study for cervicogenic headache. It is likely that this test tests the strength of the lower cervical flexors, and not the upper.

Literature
  1. Hall T, Robinson K. The flexion-rotation test and active cervical mobility – a comparative measurement study in cerviogenic headache. Man Ther. 2004;9(4):197-202.
  2. Harris KD, Heer DM, Roy TC, Santos DM, Whitman JM, Wainner RS. Reliability of neck flexor muscle endurance. Phys Ther. 2005;85(12):1349-1355
  3. Olsen L, Millar L, Dunker J, Hicks J, Glanz D. Reliability of a clinical test for deep cervical flexor endurance. J Manipulative Physiol Therapeutics. 2006;29:134-138

 

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